Public Health in the Middle Ages

People had no knowledge of need for public health, nor ways to prevent spread of disease

Roman PH facilities fell into disrepair when Romans left - no knowhow

Towns often full of animals - sheep, chickens, dogs, cats

Unpaved streets - impossible to keep clean

Houses tightly packed together

Paid officials found it difficult to remove rubbish and filth

Gvts not strong enough to create PH system

King's priority - defence & law and order

Thought to be caused by:

- Punishment from God

- Result of planets being out of alignment

- Work of Jews or other minority groups

- Miasma, dead bodies or stagnant water - more scientific people

Attempted to Cure Black Death by:

- Prayer

- Flagellants whipped themselves to repent of sins

- John of Burgundy advised avoiding baths - opening pores could let in diseases

- J of B also - Galen's theory of opposites - treating fevers with cold foods etc and avoiding hot foods like peppers and garlic

- Edward III ordered Mayor of London to remove waste and filth from streets

CONDITIONS IN C19 TOWNS

- back to back slums built

- no laws re sewers or clean water

- shared stand pipes in the streets

- rubbish, human and animal waste piled in streets

- stray animals wandering freely

- cattle and pigs lived in homes

- existing sewers quickly flooded contaminating water sources

- disease spread rapidly in overcrowded conditions

- poor life expectancy and quality compared to countryside

CHOLERA

- Board of health set up in some towns to try to prevent spread of disease

- Boards - not compulsory and most disbanded after epidemic

- 1838 research of poor's living conditions by Arnott, Kay & Smith

- Horrified by findings

- Study prompted Chadwick's nationwide survey

- Further epidemics in 1848 and 1854.... wealthy realised they could not ignore causes and effects

- Little understanding of causes of disease - eg God or miasma considered possible!

- London Doctor

- among first to use chloroform and ether as anaesthetics

- Successfully used chloroform on Q Vic in childbirth

- Came to believe cholera caused by contaminated drinking water, not airborne

- One of fathers of modern epidemiology

1854

- Snow mapped cholera cases - saw clumps in Broadway St, Soho

- 500 died in 10 days

- Snow persuaded council to remove handle on water pump

- Deaths dropped immediately

- Later discovered cesspit leaking into water supply

- Many refused his evidence

- Germ theory not yet discovered therefore miasma and spontaneous generation believed by many doctors

EDWIN CHADWICK

- 1842 published report on sanitary conditions of labouring people

- It proved that poor lived in overcrowded unhygienic conditions

- Conditions caused illness and poor life expectancy

- Absence from work caused sufferers to become poorer

- Workers had to pay higher taxes to support increasing poor

- Barrister and Social Reformer

- concerned about health of poor as it was expensive to the nation 

- Best way of reducing costs of looking after poor ....improve their health

- First President of Association of Public Sanitory Inspectors 1884

- Thought gvt should provide public health facilities - clean water, sewers & drains, clean streets

- Medical officers appointed to oversee and check this was happening

OPPOSITION TO CHADWICK REPORT

- Rich taxpayers objected to funding improvements for others, not for themselves

- Local councils didn't like to be ordered around by central government

- Many in Gvt believed in laissez-faire / non-intervention governance

Objections were silenced by spread of cholera across Europe in 1847.

In 1848 PH Act was passed.

EFFECTS OF ACT

- Setting up National Board of Health

- Gave local councils authority to improve water supplies and sewers

- Allowed councils to employ Medical Health Officers  and Med Health Board

- 1848 Act not compulsory, suggested improvements rather than forced them

- 103 councils set up Boards, most didn't

Early C 19 Gvt wanted to compile info on population.  

- appointed Farr

From 1837 Births, Marriages and Deaths recorded by law

- Farr used stats to map areas with high death rates and looked for causes

- Like Chadwick, convinced of link between poverty and poor health

- Farr's work proved unhealthy living conds and high death rates were related and shamed local councils into action

- Summer 1858 - bad conditions in London

- Water level dropped dramatically

- smell from river = THE GREAT STINK

- Disturbed MPs due to Houses of Parliament being on riverbank!

- Realised 1848 Public Health act had not done enough

Bazalgette - Engineer designed & supervised building of new sewer system

- incorporated over 1000 miles of sewer using new materials eg: portland cement

- instead of circular design, they were oval tunnel.  

- innovative design = sewers were self cleaning

Bazalgette mapped flow and tides of Thames and connected sewers so tides took waste away to sea at high tide

- took over 10 years to complete

- Hill pushed for fair rent and access to open spaces for poor tennants

- Campaigned against building on woodlands incl. Hampstead Heath

- 1865 started buying up slum houses to make them into healthy homes to show example of what could be done

- Led to 1875 Artisans' Dwelling Act - empowered local councils to clear away slums for public health reasons

- Social reformer

- pressured gvts to make pub health changes esp in housing

- teacher of poor children she had seen v poor living conditions

- family also committed to social reform

- a founder of National Trust

- believed all should have access to open spaces